Paul Heinrich

Cancer: communicating in the team game

There is increasing evidence that effective communication is a critical means by which surgeons can assist their patients to achieve the best outcomes. This paper examines the processes and outcomes of effective communication by surgeons in cancer teams, and includes: (i) strategies that promote collaborative relationships with patients and lead to more effective treatment; (ii) strategies to improve multidisciplinary team performance; and (iii) methods to minimize the risk of error and litigation. The experience of a cancer diagnosis involves radical changes in patients’ lives, somewhat akin to suddenly finding yourself in the middle of a rugby scrum for the first time. The analogy of rugby throws fresh light on such critical factors in communication as prematch preparation, orientation to the game and the team, a good kick off, sizing up the opposition, creative plays and optimizing teamwork to promote quality of life and survival.

Multidisciplinary care in cancer: the fellowship of the ring.

A young woman with advanced breast cancer came with her husband for a follow-up appointment after completing eight cycles of combination chemotherapy and trastuzumab on a clinical trial. Her scans revealed a complete response to therapy, but toxicity had been significant: she had lost her hair and a lot of weight. When I commented on her suffering, she responded that she had been to see Return of the King (the third movie in The Lord of the Rings trilogy), and she felt she had developed a “Gollum look.” Pulling off her hat, she revealed three long strands of hair over her bald scalp and thin face. The resemblance to the films’ pitiable character was indeed striking. When I asked if this was how she was feeling, she laughed, “No, I’m Frodo after destroying the ring in Mount Doom, and the eagles have just swept down to carry Sam and I to safety. We’re not sure yet where we are going, but it’s got to be better than where we have been.” We reflected for a while on what made the difference between the experience of carrying the burden of the ring (as she had identified the cancer) for Gollum and Frodo. Her response was unequivocal. Gollum had done it all by himself and had been destroyed in the process. Frodo, on the other hand, had been supported by Sam and the Fellowship—a combination of professional and intimate caregivers—and had lived to tell the tale.

Body Language and Imagery

Virtually all role-players naturally use imagery in their language and behaviour. However, most are unconscious of doing so and do not recognize the communicative power of a picture. The author’s approach is to draw attention in workshops to imagery as it occurs so that players might better access their own existing resources and expand them by borrowing from the practice of others.

Observation and Appreciation

This chapter argues that learning begins not with analysis but with appreciation. For conversation of any depth, the watching group needs to observe in a proactive way in order to notice, so that fresh insight is possible. This chapter suggests ways to develop greater powers of observation in the facilitator and in the group. Remember that every interaction is a unique event, and that the group needs to pay close attention, and to turn observation into a conscious and focused activity. Have people move their chair to where they will be most involved, or rearrange seating to change the angle of vision if the group needs to become more engaged. Encourage them to take brief notes. Provide objectives to produce discrepant awareness. Encourage nuanced description.

Where to Hold a Role-Play Workshop

This chapter applies to role-play the spatial elements introduced in Chapter 2 “Model of Performance.” The location of a venue and the arrangement of the physical space within a room are dynamic factors that determine much of the success of an event. They either actively inhibit, or foster, the virtual world necessary for the success of a workshop. Choose the location well if a dedicated space is not available. Apply principles of framing and focus to optimize the space you select. Consider lighting, seating arrangements, and placement of the stage; minimize distracting clutter; and provide the intermediate zone of a foyer. Actively counter expectations of didactic teaching and of usual workplace behaviour, and foster anticipation of exploration and experiment. Ensure that the space is actively working for you.

Beginning the Role-play Workshop

The facilitator’s first task on the day is to transport the group into the virtual world of the role-play. Before the workshop begins, therefore, facilitators need to step back from last-minute organizational issues, take time to steady the breathing and to compose themselves, and prepare imaginatively to step back into the virtual world they have created. Once the world of the workshop again comes alive around them, they are ready to step forward, to introduce themselves from within that imaginative space, and effectively to invite the group to join them. They need to have in readiness ways to manage the nerves of the first moments and a creative opening activity that will convincingly lead the group over into the virtual world.

Working With Actors

The actor is the greatest ally of the facilitator. It is the actor who most transports the role-players into the world of the workshop, draws and holds focus, compels belief by their utter commitment to the part, and demands engagement from the players. At the same time, the actor is a fellow tutor inhabiting the virtual world. The author discusses how to recruit, rehearse, and get the most value out of working with actors. He provides a list of the skills needed for convincing performance whether the actor is a professional or a natural performer. Advice is given on scripting and rehearsal, conventions of feedback, proactively maintaining the dramatic fiction, and effective ways of interacting with the actor during role-play and discussion.

Role-Play as Performance

Role-play offers experiences and insights distinctly different from those of real life. Role-play enables a group to see their usual, everyday behaviour on stage from the novel point of view of an outsider, and assuming appropriate aesthetic distance, even while they are themselves on stage. However, to make this impact and foster these insights, role-play needs to come alive. To achieve this, designers and facilitators need to access creativity throughout the process, organize well, use space thoughtfully, manage aesthetic distance artfully, cater to the particular demands of the simulation triad of actor, player, and facilitator, and recognize that only role-play, of all performance types, is intrinsically a rehearsal process. Managed well, these factors produce dynamic role-plays and accomplished facilitation.

A Model of Performance

Role-play is a subset of performance, and it follows the same conventions that bring all performances alive and compel the attention of their audiences. Organizers of any performance employ the same range of devices to minimize detachment and transport the audience into their virtual world. The management of expectations by means of aesthetic distance, the framing devices of space and time, conventions for players and audience, the focus of a stage for action, conventions of preparation and performance on it, and the final resolution of tension ensure the necessary, riveting experience of intense subjectivity radiating out from the central stage, or field. The same techniques are at play whether the performance is a sporting match, a wedding, an aesthetic performance, or a role-play workshop.

Role-Play as Rehearsal

Role-play is a rehearsal process that precedes polished, professional performance. Therefore, because the focus is on process rather than outcome, the rules of role-play are not those of the workplace but the distinctly different ones of the rehearsal room. This distinction is fundamental. Emphasis must be on safety, trust, confidentiality, and group learning. Mastery can never be assumed. Because professional interactions are so complex, and learners cannot focus on everything at once, role-play learning depends on sympathetic teachers who are prepared to grant the freedom to explore and take risks. Over time, learners become more aware and expand their repertoire. Rehearsal takes one of three forms. Training imparts new skills, workshopping expands options and repertoire, and rehearsal proper polishes for professional performance.